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Topic: does anybody else do ABA billing? (Read 1819 times)

I have a aba provider that i am working for now, who is out of network with bcbs. However she was getting the out of network rate and with the Lumenos plans that her pts have, they are supposed to pay a 40% coinsurance and almost double the deductible. On her past claims they never did, she only charges the allowed amount ( which is her fee schedule also).We are worried that now that since we have looked up this info because she was bringing on a new pt and we learned about the coins and ded for oon, that those will apply and she will eventually loose her business, because if a pt sees you for 40 hrs@ 18.75 per 15 min, that would be $3000 and coinsurance would cause the pt to pay $1200 per week, and they would go to a in network provider.

Should we submit the new claims and see what happens, does her only chargeing the allowed amount have anything to do with it?Please help!

Ok--I don't have any ABA providers in Indiana....that is why I asked. It deosn't sound right to me, but I have not looked at the Indiana Law regarding the mandate. Does your LAW state this? I have had luck with some BCBS plans, but again...every state is different. Some BCBS plans will pay one code, while other BCBS plans in a different state will say that the code is a non-covered code..........ABA has been an exciting, but quite challenging specialty for me.....As I am sure you are aware, there is no consistency in this specialty, and you may have 5 carriers all requesting you use a different code....hence the need for the AMA to create ABA specific codes! (something I am researching and have big hopes for if I can pull it off!)